From the Division of Plastic and Reconstructive Surgery, Department of Surgery (A.W.), Faculty of Medicine, Mae Fah Luang University, Chiang Rai; Division of Plastic and Reconstructive Surgery, Department of Surgery (P.S., K.W., P.P., K.J., B.C.), Department of Pathology, Faculty of Medicine (S.W., S.C.), Khon Kaen University; Division of Plastic and Reconstructive Surgery, Department of Surgery (K.E.), Khon Kaen Hospital, Khon Kaen; and Division of Plastic and Reconstructive Surgery, Department of Surgery (N.W.), Q Clinic, Bangkok, Thailand.
J Trauma Acute Care Surg. 2019 May;86(5):823-828. doi: 10.1097/TA.0000000000002179.
Clinical assessment of indeterminate burn wounds has been reported to yield poor accuracy, even when performed by burn experts. Indocyanine green (ICG) dye angiography has been found to be highly accurate in assessing burn depth, but there is still limited evidence of its use in indeterminate burn wounds. This study aims to compare the accuracy of ICG angiography to that of clinical assessment in assessing indeterminate burn wounds.
This is a prospective, multicentered, triple-blinded, experimental study. Participants were stable patients, admitted to the hospital with burn wounds of indeterminate depth. The burn wounds were clinically assessed by an attending plastic surgeon. ICG angiography was performed and evaluated by another surgeon. Tissue biopsies were obtained and sent for histological study to be assessed as the gold standard.
In the 30 burn sites that were assessed, the accuracy of ICG angiography was 100.0%, compared with 50.0% for clinical assessment (p < 0.001). Clinical assessment yielded a sensitivity of 33.3% and specificity of 66.7%, while ICG angiography yielded both a sensitivity and specificity of 100.0%. Therefore, the number needed to treat for using ICG angiography in indeterminate burn wounds was two.
Indocyanine green angiography yields a significantly higher accuracy than clinical assessment in indeterminate burn wounds. This intervention can, thus, be a useful tool to aid clinical judgment.
Thai Clinical Trials Registry, number TCTR20170821001.
Diagnostic test, level I.
临床评估不确定的烧伤创面被报道准确性较差，即使由烧伤专家进行评估也是如此。吲哚菁绿（ICG）染料血管造影术已被发现非常准确地评估烧伤深度，但在不确定的烧伤创面中的应用证据仍然有限。本研究旨在比较 ICG 血管造影术与临床评估在评估不确定烧伤创面中的准确性。
这是一项前瞻性、多中心、三盲、实验研究。参与者为稳定的烧伤患者，因不确定深度的烧伤而住院。由一名主治整形外科医生对烧伤创面进行临床评估。进行 ICG 血管造影术，并由另一名外科医生进行评估。获取组织活检并进行组织学评估作为金标准。
在评估的 30 个烧伤部位中，ICG 血管造影术的准确性为 100.0%，而临床评估的准确性为 50.0%（p < 0.001）。临床评估的敏感性为 33.3%，特异性为 66.7%，而 ICG 血管造影术的敏感性和特异性均为 100.0%。因此，在不确定的烧伤创面中使用 ICG 血管造影术的治疗需要数为 2。
ICG 血管造影术在不确定的烧伤创面中的准确性明显高于临床评估。因此，该干预措施可以成为辅助临床判断的有用工具。
泰国临床试验注册中心，编号 TCTR20170821001。
诊断性试验，一级。
